原发性肺腺癌患者脑转移时间的相关因素分析

Analysis of related factors predicting time intervals of brain metastasis of patients with primary lung adenocarcinoma

目的 探讨不同临床因素与肺腺癌患者首次确诊到继发性脑转移时间的关系。方法 回顾性分析自2015年1月~2020年1月在哈尔滨医科大学附属肿瘤医院286例首次诊断为肺腺癌及在后期检查过程中确诊为脑转移瘤患者的临床病理资料。结果 单因素分析结果显示,TNM分期为Ⅳ期的患者更快脑转移(P=0.022);有淋巴结转移患者更快发生脑转移(P=0.034);有远处转移患者更快发生脑转移(P<0.001);进行化疗的患者更慢发生脑转移(P<0.001);进行靶向治疗的患者更慢脑转移(P=0.006);进行过放疗的患者更慢发生脑转移(P<0.001);进行手术的患者更慢发生脑转移(P<0.001);有上皮生长因子受体(epidermal growth factor receptor, EGFR)突变的患者更快发生脑转移(P=0.003);多因素分析结果显示,全程化疗(P<0.001)、靶向治疗(P=0.01)、手术治疗(P=0.012)、放疗(P<0.001)为肺腺癌发生脑转移的独立预测因素。结论 手术、全程化疗、放疗及靶向治疗是肺腺癌脑转移时间的独立预测因素,肺腺癌脑转移时间与EGFR的关系还有待进一步补充研究。

Objective To investigate the relationship between different clinical factors and the time from first diagnosis to secondary brain metastasis in patients with lung adenocarcinoma. Methods To retrospectively analyze the clinicopathological data of 286 patients with first diagnosis of lung adenocarcinoma and brain metastases diagnosed during late examination at the Affiliated Cancer Hospital of Harbin Medical University from January 2015 to January 2020. Results Univariate analysis showed that patients with clinical stage Stage Ⅳ patients had faster brain metastasis(P=0.022);patients with lymph node metastasis had faster brain metastasis(P=0.034);patients with distant metastasis had faster brain metastasis(P<0.001);patients who had chemotherapy had slower brain metastasis(P<0.001);patients who had targeted therapy had slower brain metastasis(P=0.006);patients who had radiotherapy had slower brain metastases(P<0.001);patients who had surgery were slower to develop brain metastases(P<0.001);patients with epidermal growth factor receptor(EGFR) mutations were faster to develop brain metastases(P=0.003);multifactorial analysis showed that full chemotherapy(P<0.001), targeted therapy(P=0.01), surgery(P=0.012) and radiotherapy(P<0.001) were independent predictors of brain metastases in lung adenocarcinoma. Conclusion Surgery, full chemotherapy, radiotherapy and targeted therapy are independent predictors of time to brain metastasis in lung adenocarcinoma.The relationship between time to brain metastasis and EGFR in lung adenocarcinoma needs further additional study.